摘要
目的分析胰岛β细胞瘤患者72h血糖谱的特点,讨论持续动态血糖监测(CGM)在鉴别低血糖(尤其是胰岛β细胞瘤中)的应用价值。方法连续纳入2009年10月至2011年11月在我院内分泌代谢科住院的胰岛β细胞瘤患者6例(A组,术后病理检查证实);另纳入71例糖耐量正常者(NGT)为对照组(B组)、3例反应性低血糖患者为C组。3组受试者均行口服葡萄糖耐量试验(OGTT)及胰岛素释放试验,并应用持续动态血糖监测系统(CGMS)进行连续3d的血糖监测。结合EasyGV分析CGM的平均血糖水平(MBG)、血糖标准差(SD)、低血糖指数(LBGI)、糖尿病血糖风险评估值(GRADE)、M-值(M-value)、日间血糖平均绝对差(MODD)、平均血糖波动幅度(MAGE)及低血糖事件及时间分布。结果①A组患者糖化血红蛋白、空腹血糖及OGTT后2h血糖较B组降低(P均<0.05)。②通过CGM发现,A组72hMBG低于B组(P<0.001),A组GRADE值、LBGI、M-value、SD及MODD均较B组高(P均<0.05)。③A组患者佩戴CGMS期间,其中有5例患者发生低血糖事件(血糖<2.8mmol/L)共27次,多在凌晨及早餐空腹,B组仅2例共发生了2次低血糖事件,C组1例发生2次低血糖事件。结论胰岛β细胞瘤日内血糖波动更大,低血糖发作频繁,以深夜、空腹及餐前低血糖居多。CGMS结合EasyGV关于低血糖风险方面的参数有助于诊断胰岛β细胞瘤。
Objective To identify the characteristics of glucose profiles in patients with insulinoma using continuous glucose monitoring system（CGMS）.Methods Six patients with insulinoma（All of the patients were diagnosed after operations with pathological tests）admitted to the Department of Endocrinology and Metabolism,West China Hospital of Sichuan University from October 2009to November 2011were recruited for this study（group A）.They were compared with 71patients with normal glucose tolerance（NGT）（group B）and 3patients with responsive hypoglycemia（group C）.All of the participants received 75g oral glucose tolerance tests（OGTT）,insulin release tests,and 72hCGM.Glucose fluctuations and hypoglycemia risks were assessed by the following parameters obtained from CGMS：mean blood glucose（MBG）and standard deviation（SD）,mean amplitude of glycemic excursion（MAGE）,mean daily differences（MODD）,low glucose index（LBGI）,glycaemic Risk Assessment Diabetes Equation（GRADE）and M-value.Results Group A had significantly lower levels of HbA1c,fasting blood glucose,and 2h-BG than group B（P＆lt;0.05）.Compared with Group B,Group A had lower levels of72h-MBG（P＆lt;0.001）and higher levels of LBGI,M-value,GRADE,SD and MODD（P＆lt;0.05）.The insulinoma patients had 27occasions of hypoglycemia（glucose＆lt;2.8mmol/L）,more likely in early morning,at a fasting state or preprandial periods.Such events were rare in the control groups（2occasions in Group B and one occasion in Group C）.Conclusion Insulinoma patients present a greater level of glucose fluctuations and frequent hypoglycemia.Hypoglycemia risk detected by CGM is helpful for differentiating diagnosis of insulinoma.
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2014年第4期623-627,共5页
Journal of Sichuan University(Medical Sciences)
基金
四川省科技厅科技支撑项目(No.2011SZ0220)资助
关键词
低血糖
胰岛Β细胞瘤
动态血糖监测
Hypoglycemia Insulinoma Continuous glucose monitoring
